A radio spot that debuted on Wednesday and paid for by the Democratic-NPL is trying to deflect criticism directed at the state's congressional delegation and hit the state's GOP where it hurts: their credibility as fiscal conservatives.

Consider it the latest blow of the 2010 election.

"Here are some facts Republicans don't want you to know," the advertisement's narrator says. "The biggest spender in North Dakota history is Republican Gov. John Hoeven."

The ad notes the 2009 legislative session ended with a 26 percent increase in state spending, while Hoeven has presided over state budgets that have led to an overall increase of 86 percent.

The ad isn't a big surprise. Sen. Byron Dorgan, D-N.D., could be facing a competitive re-election bid in 2010 if Hoeven decides to challenge him.

Don Canton, Hoeven's spokesman, said, "It's pretty ridiculous for them to attack us on fiscal stewardship when the Democrats have pushed to spend more in every single session.

"We welcome the comparison of our fiscal stewardship with the work of Congress, which is bankrupting the country with multitrillion-dollar deficits," he said, adding that the governor and the Republican-led Legislature, during the 2009 session, cut property and income taxes, funded state programs and left an estimated $700 million in reserves.

Pomeroy subject of poll

A poll that pitted Hoeven and Dorgan against each other last month also included some polling figures on Rep. Earl Pomeroy, D-N.D.

The poll, conducted by GOP polling firm Public Opinion Strategies, gave Pomeroy a 63 percent approval rating, while only 24 percent of North Dakotans polled said the country was headed in the right direction.

Gene Ulm, a polling consultant for the firm, said that could mean incumbents may be in trouble in 2010 if the economy continues to falter and pocketbook issues stay on the minds of North Dakotans.

The poll also pitted Pomeroy against two Republicans: Public Service Commissioner Kevin Cramer and U.S. Attorney Drew Wrigley, who has said he does not want to run for Congress.

In the poll, Pomeroy beat Cramer 46 percent to 42 percent, and beat Wrigley 44 percent to 40 percent, which GOP officials say is a low performance for an incumbent who won his last three re-elections with more than 60 percent of the vote. The poll was partially funded by the National Republicans Congressional Committee.

Cramer, who lost to Pomeroy in 1996 and 1998, said the poll "is a factor in the decision-making process, but a pretty minor one."

He said he's in no hurry to enter the 2010 race, adding a potential Hoeven candidacy could be favorable to Republicans, but could also "overwhelm every other race."

Answering questions on health care

Jeanette Kolberg asks why her health insurance premium with Blue Cross Blue Shield of North Dakota has increased. Without knowing the details of her situation, it's more appropriate to answer a broader question: Why are the Blues increasing health insurance premiums?

North Dakota Insurance Commissioner Adam Hamm said the Blues have requested rate increases each year since 2001. He said it boils down to six factors:

n Price inflation and increased reimbursement costs to doctors.

n An increased use of medical services, possibly because of an aging population that uses the services more.

n Paying for people who use medical services who do not have insurance.

n Deductibles and co-payments that do not change, which requires the insurance company to increase its reimbursements to doctors.

n New medical technologies that cost more and require high reimbursements to medical providers.

n Government mandates.

The Blues asked for a 14.8 percent rate increase for its individual plans in May 2008, but were denied by Hamm. Those plans cover 33,762 North Dakotans.

As for the group plans, which cover about 113,000 North Dakotans, Hamm ultimately approved a 7.9 percent premium increase in May after the company requested a 14.9 percent increase last fall that was initially denied.

She also asked whether or not Blue Cross Blue Shield of North Dakota is a cooperative and if Sen. Kent Conrad's, D-N.D., proposed health care cooperatives would lower health care costs around the nation.

The Blues are a not-for-profit, member-owned mutual insurance company, which means its members elect the board of directors and company has no capital stock and pays no dividends.

As for the cooperative proposal, it's hard to quantify the overall effect it will have on the nation's health care system. However, the nonpartisan Congressional Budget Office has said the House version, which includes the so-called public option, would increase costs over time.

Such an analysis has not been done for the bill Conrad is working on in the Senate Finance Committee, which includes the health care cooperatives.

So, long answer short, there's no quantifiable data on health care cooperatives - yet.

And while the health care cooperatives that already exist do not produce dramatically lower costs, Conrad's office says health care cooperatives would "produce cost savings through the absence of a profit motive, reduced administrative costs, and by helping reform how we pay for health care."

(Reach reporter Brian Duggan at 223-8482 or brian.duggan@;bismarcktribune.com.)